Healthcare Provider Details

I. General information

NPI: 1083578710
Provider Name (Legal Business Name): LEF ANGELIQUE CANO MORALES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E GENERAL SCREVEN WAY
HINESVILLE GA
31313-3014
US

IV. Provider business mailing address

78 MAGGIE LN
ALLENHURST GA
31301-3008
US

V. Phone/Fax

Practice location:
  • Phone: 912-877-3002
  • Fax:
Mailing address:
  • Phone: 917-756-0718
  • Fax: 917-756-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033880
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: